Nwosu, Marjorie Mabong
Nwosu, Marjorie Mabong is an individual health care provider with primary practice located at 3505 Broadway , Mount Vernon IL 62864. She recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as her primary health care specialty. Nwosu, Marjorie Mabong can be contacted via phone (618) 242-3495.Contact Information
Primary practice address
3505 Broadway
Mount Vernon IL 62864
Phone: (618) 242-3495
Fax: (618) 241-8775
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Pediatrics | 208000000X | 4301068282 | Michigan |
Profile Details
| NPI number | 1932164951 |
|---|---|
| LBN Legal business name | Nwosu, Marjorie Mabong |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Apr 20th, 2006 |
| Last updated | May 23rd, 2012 - about 12 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1932164951 | NPPES |
| Other | P00792826 | RR INDIVIDUAL # | |
| MEDICAID | 1932164951 | RR INDIVIDUAL # | |
| Other | 833230 | RR INDIVIDUAL # | |
| Other | 35-0-41-0927-2 | RR INDIVIDUAL # | |
| Other | CA2182 | RR INDIVIDUAL # |
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